Nonulcerating bacterial keratitis associated with soft and rigid contact lens wear

Objective: An unusual presentation of contact lens-related bacterial keratitis is that of epithelial nodular infiltrates and stromal inflammation without epithelial ulceration. The authors study the initial diagnosis, clinical features, causative organisms, and outcomes of corneal infections presenting in this manner. Design: The study design was a 20-month retrospective chart review. Participants: Five patients with culture-proven bacterial keratitis who had predominantly nodular epithelial lesions were studied. Results: Four infections were associated with soft contact lens wear and one with rigid lens wear. All patients had largely intact epithelium; typical gray-colored epithelial nodules, some with underlying anterior stromal haze; and diffuse, fine, cellular stromal inflammation. Two patients were referred with the tentative diagnosis of Acanthamoeba infection and two as contact lens-related sterile keratitis. Epithelial cultures from three cases yielded Serratia sp., one yielded Corynebacterium, and one Streptococcus pneumoniae. All responded to antibacterial medication; final corrected visual acuity in all cases was 20/30 or better. Conclusions: Bacterial infection associated with contact lens wear can be established within the corneal epithelium without initially producing an ulcer. A wide range of both gram-positive and gram-negative organisms can be involved. Early recognition and treatment appear to result in a favorable outcome.